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Full text of "Diseases Of The Nose Throat And Ear"

52                   THE NOSE AND PARANASAL SINUSES

The natural history of the catarrhal child who presents no factors such as
recurrent tonsillitis, otitis media or bronchial trouble requiring a specific
form of treatment is one of slow improvement. The symptoms are at their
height when the child goes to school, either when the town child goes to
nursery school or when the country child, reared perhaps in isolation on a
farm, goes to primary school at which he first comes into close contact with
numbers of other children. Absences are frequent in the first year at school
and, again provided that infected tonsils or middle ears do not develop, the
natural sequence of events is for the child to develop his own immunity, if he
is allowed to do so, and he may well outgrow these infections by the time he
reaches the age of 8 or 9 years.

There are many children who do not pursue this course which is relatively
benign in spite of frequent absences from school. Such children develop
recurring infections of lymphoid tissue of the pharynx and nasopharynx, when
their illnesses become more serious. They have frequent attacks of follicular
tonsillitis, or of acute or chronic otitis media. Some develop bronchitis at an
early age and a proportion of these may degenerate into bronchiectasis. In
this group treatment must be positive rather than expectant because such
children may be sowing the seeds of ill-health later in life.

Lastly there is the allergic group who may progress from infantile eczema
to allergic rhinitis perhaps with exacerbations of hay fever at the pollinating
season and so to asthma. Many of these children appear to grow out of their
allergy when the eczema finally heals, but an appreciable percentage persist
with nasal catarrh and stuffiness, so that their allergens should be sought for
and, where possible, avoided or treated.

TREATMENT. In the early stages this should be medical and hygienic in the
widest sense. Training may have to begin with the parents by teaching them
how to house, feed and look after their children. Early training in nasal
hygiene and nose blowing prevents infected mucopus lying in the child's nose.
No hard-and-fast rules can be laid down for the timing of this, but when a
child goes to school he should be capable of blowing his own nose, and should
be aware of when this is required. Yet it is not uncommon to give a child a
swab and ask him to blow his nose in the outpatient department only to find
that a 9-year-old has no idea of what this means. Mucopus lying in the child's
nose obstructs air entry into and drainage from the nasal sinuses. Simple nose
breathing exercises allow the nasal mucosa a chance tcsrecover its normal
function. Nasal mucus, containing the bactericidal lysozyme, and the ciliated
epithelium are the best natural defences a child has against infection. If they
are aided by good home conditions and a well-balanced diet with plenty of
vitamins the child's natural resistance to disease will be greatly strengthened.

Antibiotics should be reserved for serious infections, and not prescribed
for the common cold. Certain children, however, may require antibiotic
therapy for any acute infection, and among these are sufferers from muco-
viscidosis or children with congenital cardiac lesions. Some susceptible
children may be given a long-term course of antibiotic therapy under the
supervision of the paediatrician.

Children with nasal allergy may be treated with antihistamines and by
nasal drops of 0-5 per cent ephedrine hydrochloride in normal saline, reserving
corticosteroids either in nasal sprays or by mouth for the established cases of
bronchospasm. Many children combine a basic atopy with a mild chronic